neuro eval lecture 8
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jobs of the cerebellum
- coordinated activity - fluid movement and postures
- comparison of motor activities (did the movement match the pre-movement plan?)
- modification of motor output based on sensory input and prior motor output
- compensation for motor tasks
- predictive/anticipatory mvmnts - to get body read for mvmnt -like bracing when you see someone running towards you
- learning new motor programs
how to eval a loss of anticipatory balance skills
- have pt stand eyes closed feet together
- someone who's impaired will sway, and won't catch himself until he's falling - he won't react to the loss of balance until it's too late to do a simple adjustment
one reason recovery frm a cerebellar injury is extra tough
the cerebellum plays a big role in learning...
vestibulocerebellum aka archicerebelum - lesions --> ? - receives input from and outflow to __
- lesions --> inability to utilize vestibular inputs - therefore an inability to adjust to those inputs...
- vestibular nuclei
spinocerebellum/paleocerebellum - gets input from where? what is it in charge of?
- input from spinocerebellar tracts
- movement completion and muscle tone (this tone regulation is unrel to spasticty -it's about support muscle tone - like tightening your core as you pick up a heavy box - w/cerebellar lesions force becomes erratic -- pushing a button you'll vacillate between lots and little pressure)
cerebrocerebellum (neocerebellum) - where is it, input from where, output to where?
- lateral cerebellar hemispheres
- input from pontine nuclei
- output to thalamus, motor and premotor cortex
cerebrocerebellum/neocerebellum controls what?
- control of rapid movement
- precise movement control
- motor planning
lesions where cause dysmetria and disdiadochokinesia
cerebrocerebellum / neocerebellum
- (due to lesion in the cerebrocerebellum/neocerebellum)
- inability to accurately jude the speed, force, or distance needed for a task
movement decomposition - lack of movement fluidity
8 signs of cerebellar dysfunction
- rebound phenomena
- ataxic gait
- cerebellar speecy - dysarthria
- nystagmus and impaired extraocular movements
- "lack of check"
- pt flexes arm to 90 and tries to keep it here while PT tries to push it down
- when PT suddenly releases arm should go up just once - if there's a lesion it'll bounce up and down and up and down
due to loss of control over diaphram, this speech will sporadically change in volume and intensity
test for dysmetria
- finger-nose-finger at diff ranges, speeds, location
- heel-shin test
don't mistake weakness, spasticity, sensory loss for dysmetria!
difficulty w 2 alternating movements / impaired ability to perform rapid, alternating movements in hands or feet
don't mistake weakness, spasticity, contraction, or sensation troubles for a pos dis sign
components of mvmnt that can be messed up in disdiadochokinesia
test for disdiadochokinesia
- flip flop hands on thighs
- tap toes heels toes heels on floor
nice thing regarding cerbellar damage
the cerebelum is densly packed, so there's a good probability of neuroplasticity
- cerebellar issues of the neck
- fyi - can have cerebellar findings for jut one area - eyes, neck, etc
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